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What are the two categories of acute muscle injuries? Contusions Contusions Strains Strains

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How does one receive a contusion? Sudden traumatic blow to the body

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What is typical in cases of severe contusions? a. the athlete reports being struck by a hard blow b. the blow causes pain and a transitory paralysis caused by pressure on and shock to the motor and sensory nerves c. palpation often reveals a hard area, indurated because of internal hemorrhage d. ecchymosis, or tissue discoloration, may take place

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What is a strain? A stretch, tear, or rip in the muscle or adjacent tissue such as the fascia or muscle tendon

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How are strains most often produced? Abnormal muscular contraction

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What is the cause of abnormal muscular contraction? It is fault in the reciprocal coordination of the agonist and antagonist muscles take place. The cause of this fault or un-coordination is a mystery. However, possible explanations are that it may be related to: a mineral imbalance caused by profuse sweating a mineral imbalance caused by profuse sweating to fatigue metabolites collected in the muscle itself to fatigue metabolites collected in the muscle itself to a strength imbalance between agonist and antagonist muscles. to a strength imbalance between agonist and antagonist muscles.

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What is a grade 1 (or 1 st degree or 1°) strain? Slight over-stretching to mild tearing (20%) of the muscle fibers. It is accompanied by local pain, which is increased by tension in the muscle, and a minor loss of strength. There is mild swelling, ecchymosis, and local tenderness.

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What is a grade 2 (or 2 nd degree or 2°) strain? Moderate tearing (20% - 70%) of the muscle fibers. It is similar to a grade 1, but has moderate signs and symptoms (moderate loss of strength, moderate swelling, ecchymosis, and local tenderness).

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What is a grade 3 (or 3 rd degree or 3°) strain? Has signs and symptoms that are severe (severe swelling, ecchymosis, and local tenderness) with a loss of muscle function and, commonly, a palpable defect in the muscle.

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What does a tendon attach? Muscle to bone

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What does a ligament attach? Bone to bone

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What is a cramp? A painful involuntary contraction of a skeletal muscle or muscle group.

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Cramps have been attributed to what? A lack of water or other electrolytes in relation to muscle fatigue.

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What is a spasm? A reflexive reaction caused by trauma of the musculoskeletal system

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List and define the two types of spasms or cramps: a. clonic – alternating involuntary muscular contraction and relaxation in quick succession b. tonic – rigid muscle contraction that lasts a period of time.

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List and define the two types of muscle soreness: a. Acute-onset muscle soreness – which accompanies fatigue. This muscle pain is transient and occurs during and immediately after exercise. b. Delayed-onset muscle soreness (DOMS) – becomes most intense after 24 to 48 hours and then gradually subsides so that the muscle becomes symptom-free after 3 or 4 days. (This second type of pain is described as a syndrome of delayed muscle pain leading to increased muscle tension, swelling, stiffness, and resistance to stretch).

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What are the possible causes for delayed-onset muscle soreness? It may occur from very small tears in the muscle tissue, which seems to be more likely with eccentric or isometric contractions. It may occur from very small tears in the muscle tissue, which seems to be more likely with eccentric or isometric contractions. It may also occur because of disruption of the connective tissue that hold muscle tendon fibers together. It may also occur because of disruption of the connective tissue that hold muscle tendon fibers together.

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What is muscle stiffness? Muscle stiffness does not produce pain. It occurs when a group of muscles have been worked for a long period of time. The fluids that collect in the muscles during and after exercise are absorbed into the bloodstream at a slow rate. As a result, the muscle becomes swollen, shorter, and thicker and therefore resists stretch.

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What is muscle guarding? Following injury, the muscle that surrounds the injured area contract, in effect, splint that area, thus minimizing pain by limiting movement. (Quite often this splinting is incorrectly referred to as a muscle spasm)

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What are the major acute injuries that happen to synovial joints? Sprains Sprains Subluxations Subluxations Dislocations Dislocations

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What is a sprain? Stretching or total tearing of the stabilizing connective tissues (ligaments)

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What is a grade 1 (or 1 st degree or 1°) sprain? Slight over-stretching to mild tearing (20%) of the ligament. It is characterized by some pain, minimum loss of function, mild point tenderness, little or no swelling, and no abnormal motion when tested.

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What is a grade 2 (or 2 nd degree or 2°) sprain? Moderate tearing (20% - 70%) of the ligament. There is pain, moderate loss of function, swelling, and in some cases slight to moderate instability.

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What is a grade 3 (or 3 rd degree or 3°) sprain? It is extremely painful, with major loss of function, severe instability, tenderness, and swelling.

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What is a subluxation? Partial dislocations in which an incomplete separation between two articulating bones occurs.

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What is a dislocation (luxation)? Total disunion of bone apposition between articulating surfaces

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What are several factors that are important in recognizing and evaluating dislocations? Loss of limb function Loss of limb function Deformity Deformity Swelling Swelling Point tenderness Point tenderness

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What is an acute bone fracture? A partial or complete interruption in a bone’s continuity

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What is a stress fracture? Rhythmic muscle action performed over a period of time at a sub-threshold level causes the stress-bearing capacity of a bone to be exceeded

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What are the typical causes of stress fractures in sports? Coming back into competition too soon after an injury or illness Coming back into competition too soon after an injury or illness Going from one event to another without proper training in the second event Going from one event to another without proper training in the second event Starting initial training too quickly Starting initial training too quickly Changing habits or the environment Changing habits or the environment

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Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment Shoulder dislocation/subluxation Forced abduction, external rotation, direct blow Typical, Typical, possible deformity, unable to touch opposing shoulder (Apley’s scratch test Typical, Typical, Immediate immobilization, RICE, pillow under the arm for comfort, physician referral, x-rays to rule out a fracture Elbow dislocation Fall on the outstretched hand with the elbow in a position hyperextension; or a severe twist while it is in a flexed position. Typical, Typical, Rupturing or tearing most of the stabilizing ligaments, profuse hemorrhage and swelling. Severe pain and disability, possible radial head fracture. Typical, Typical, sling, physician referral Lunate Dislocation Forced hyperextensionTypical, difficulty in executing wrist and finger flexion. There may be numbness or even paralysis of the flexor muscles because of lunate pressure on the median nerve Typical, Typical, possible physician referral Finger dislocations/subluxations Direct trauma or violent twistingTypicalTypical Lumbar Vertebrae DislocationCompression fracture may occur as a result of hyperflexion of the trunk; falling from a height and landing on the feet or buttocks; direct impact from a sudden blowTypical Typical, Typical, X-ray, physician referral, put athlete on a spine board Cervical dislocation Violent flexion and rotation of the head Point tenderness, restricted movement, cervical spasm, cervical pain and pain in the chest and extremities, numbness in the trunk and/or limbs, weakness or paralysis in the trunk and/or limbs, loss of bladder and/or bowel control C-spine, C-spine, Physician referral Dislocations and Subluxations

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Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment Talus Fracture Occurs either laterally from a severe inversion and dorsiflexion force or medially from an inversion and plantar flexion force with external rotation of the tibia on the talus. Typical, History of repeated trauma to the ankle, feels pain on weight bearing, complaint of snapping or catching, intermittent swelling, anteromedial or anterolateral joint line of the talar dome is tender when palpated. Typical, X-ray is essential for an accurate diagnosis, non-surgical management for a non-displaced sub-chondral compression fracture, protective immobilization, non-weight bearing progression to full weight bearing depending on symptoms, if conservative treatment fails surgery may be required, expect to resume activity 6 to 8 months after surgery. Calcaneal Fracture Occurs most often after a jump or fall from a height. An avulsion fracture can also occur with this injury Typical, inability to bear weight Typical, X-ray is essential for an accurate diagnosis, non-surgical management for a non-displaced fracture, protective immobilization, non-weight bearing progression to full weight bearing depending on symptoms, Calcaneal Stress Fracture Occurs from repetitive impact during heel strike and characterized by a sudden onset of constant pain in the plantar-calcaneal area. Typical, Typical, Feels pain on weight bearing, pain tends to continue after exercise stops, bone scan may be required. Typical, Typical, Conservative management for the first 2 to 3 weeks, rest, active ROM exercises of the foot and ankle, non-weight bearing cardiovascular exercises, may resume activities within pain limits when pain subsides, must wear a cushioned shoe. Jone’s Fracture Inversion and plantar flexion of the foot, direct forces, or repetitive stress. Typical, Immediate swelling and pain over the 5th metatarsal, high non- union rate, coarse of healing is unpredictable. Typical, Typical, Crutches with no immobilization, gradually progress to full weight bearing as pain subsides, return to activity is possible in 6 weeks, non-union may cause re- fracture to occur. Fractures (cont.)

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Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment Metatarsal Stress Fracture (March Fracture) Most commonly involves the shaft of the 2nd metatarsal (March fracture). Occurs in the runner suddenly changing training patterns, such as increasing mileage, running hills, or running on a harder surface. An atypical condition such as a structural forefoot varus, hallux valgus, or a short 1st metatarsal will predispose to a 2nd metatarsal stress fracture. A stress fracture of the 5th metatarsal at the insertion of the peroneous brevis tendon can occur, but should not be confused with a Jones fracture. TypicalTypical, Bone scan is the best way to detect this injury, 3 or 4 days of partial weight bearing after two weeks of rest, return to running should be gradual, orthotics can help to reduce stress PhalangesOccurs by either kicking an object, stubbing a toe, or being stepped on. Dislocations are less common than fractures. Typical, deformity. Stiffness and residual pain may last for several days Typical, buddy tape, possible physician referral Clavicular FractureFall on the outstretched, a fall on the tip of the shoulder, or direct impact. Typical, Clavicle appears slightly lower than the opposite side. possible deformity Typical, Sling and swathe, treat for shock, X-ray, immobilization for 6 to 8 weeks. After immobilization, begin gentle isometrics and mobilization exercises. May require surgery. Scapular Fracture Direct impact or force transmitted through the humerus to the scapula. Typical, Pain during shoulder movement Typical, Sling, x-ray, begin overhead strengthen in 1 week. Fracture of the Humerus Direct blow or fall on the outstretched arm Typical, inability to move armTypical, Sling and swathe, treat for shock, physician referral, immobilization for 6 to 8 weeks Fractures (cont.)

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Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment Anterior Tibialis Tendinitis Common when running downhill for extended periods of time. TypicalTypical, avoid hills Posterior Tibialis Tendinitis Overuse injury among runners with hypermobility or pronated feet Typical, Swelling of the medial malleolus area, edema and point tenderness behind the medial malleolus area, pain can become more intense during resistive inversion and plantar flexion Typical, non-weight bearing short-leg cast with the foot in inversion may be used, Low Dye taping or orthotic can be used to correct pronation. Peroneal Tendinitis Problem in athletes with pes cavus where the foot tends to excessive supinate. Typical, Pain of the lateral malleolus area when rising on the ball of the foot, tenderness behind the lateral aspect of the calcaneous distally beneath the cuboid. Typical, tape with elastic tape, appropriate warm-up and flexibility exercises, Low Dye taping or orthotic can be used to prevent excessive supination. Wrist tendinitis Repetitive pulling movementsTypicalTypical Tendinitis (cont.)

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de Quervain’s Disease (Hoffman’s Disease) Etiology: Etiology: Constant wrist movement Constant wrist movement Signs & Symptoms: Signs & Symptoms: Aching pain which may radiate into the hand or forearm, positive Finklestein’s test; point tenderness and weakness during thumb extension and abduction; there may be a painful snapping and catching of the tendons Aching pain which may radiate into the hand or forearm, positive Finklestein’s test; point tenderness and weakness during thumb extension and abduction; there may be a painful snapping and catching of the tendons Treatment: Treatment: Immobilization, rest cryotherapy, NSAIDs, ultrasound, ice massage Immobilization, rest cryotherapy, NSAIDs, ultrasound, ice massage

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Sciatica Etiology: Etiology: Torsion or direct blow to the back causing inflammation or compression of the sciatic nerve Torsion or direct blow to the back causing inflammation or compression of the sciatic nerve Signs & Symptoms: Signs & Symptoms: Pain may be abrupt or gradual, produces a sharp shooting pain that follows the nerve pathway along the posterior and medial thigh; there may be tingling and numbness along its path; nerve may be extremely sensitive to palpation; straight leg raises intensifies pain. Pain may be abrupt or gradual, produces a sharp shooting pain that follows the nerve pathway along the posterior and medial thigh; there may be tingling and numbness along its path; nerve may be extremely sensitive to palpation; straight leg raises intensifies pain. Treatment: Treatment: Rest is essential. Stretching of a tight piriformis muscle may decrease symptoms; NSAIDs and RICE, surgery may be necessary. Rest is essential. Stretching of a tight piriformis muscle may decrease symptoms; NSAIDs and RICE, surgery may be necessary.

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Brachial Plexus Neurapraxia (Burner or Stinger) Etiology: Etiology: Stretching or compression of the brachial plexus Stretching or compression of the brachial plexus Signs & Symptoms: Signs & Symptoms: Burning sensation, numbness, tingling, and pain extending from the shoulder down to the hand with some loss of function of the arm and hand that lasts for several minutes. Burning sensation, numbness, tingling, and pain extending from the shoulder down to the hand with some loss of function of the arm and hand that lasts for several minutes. Treatment: Treatment: RICE; strengthening exercises; Athlete may return to full activity once symptoms have completed resolve and there are no associated neurological symptoms. RICE; strengthening exercises; Athlete may return to full activity once symptoms have completed resolve and there are no associated neurological symptoms.